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How to fill out the lab requisition form
Once you receive the test kit from the lab you will need to refer back to this page to fill out the requisition form enclosed in the box.

Inside the test kit you will find the lab requisition form.

We have simplified the information required for you to fill out.

1.On the top Left, in the Bill To section: check the Physician Account box.

2. On the top right corner, check the Toxic Element Clearance Profile.

The Comprehesive Urine Element Profile is NOT Available at this time.

DO NOT check the Comprehensive Urine Element Test.

3. The Diagnosis Code is NOT required. 

4. Collection duration- Check the Timed box and write in 16 hours.

5. It is NOT required to record the Total Volume of Urine.

6. Under Provocation:  Mark Post-Provocation

Fill in:  Provocation Agent:  Natural Cellular Defense-Zeolite

7. Physician Signature is NOT required.

8. Fill out Patient Information

9. Important:  Fill in Date Final Sample Collected.

10. Be sure to sign form.

11. Do NOT fill out the Insurance Information Section.

Insurance and Medicare billing are not available thought this site.  This allows the cost of the test to remain inexpensive. 

If you wish to bill this type of testing to your Insurance or Medicare, you must find a local health care provider to obtain the testing.

12. Do NOT fill out Check or Credit Card Information.  Your test is pre-paid through the website.

13. Follow instructions for collecting samples and placing in vials. It is NOT necessary to write Total Urine Volume on the vials of urine.

14. Put the requisition form and the urine sample in the box. 

15. Call DHL at 1-800-247-2676 to schedule a pick-up.

16. Refrigerate test kit until day of  pick-up.

17. Some of the instructions may seem contradictory on this site compared to the requisition form you receive. . Please follow these instructions carefully and don't worry! The main concerns are outlined above for a successful collection and shipment.

18. The shipment bag is not to be folded. Pull the adhesive  strip off from inside the bag on one side  and press the bag together to seal.